Use of Immune Checkpoint Inhibitors in End Stage Kidney Disease Patients, Single Center Experience and Review of the Literature.

Abstract

Immune checkpoint inhibitors (ICIs), immunomodulatory antibodies that are used to enhance the immune system, have substantially improved the prognosis of patients with advanced malignancy. Although we are aware that there is no renal clearance of these agents (1), the data on the use of ICIs in patients with ESKD on hemodialysis (HD) as well as those on peritoneal dialysis (PD) is sparse. Published reports on the use of ICIs in patients with ESKD are limited to case reports and case series: one from Korea (2) and the second from Italy (3). We describe our single-center experience of ICI use in patients with ESKD and summarize the current literature of ICI use in this population. We used data from a large health system in the state of New York comprising 23 hospitals and >700 ambulatory facilities. Data for this study were obtained from the enterprise inpatient electronic health record (Sunrise Clinical Manager; Allscripts, Chicago, IL), which covers 13 of the hospitals, including the oncology infusion centers. Using an analytics database, we identified all patients with a minimum of one ESKD diagnosis code (Insertional Classification of Diseases 10th Edition, N18.6) who received at least one of the following agents between 2012 and 2019: ipilimumab, nivolumab, pembrolizumab, or atezolizumab. We included both prevalent patients on dialysis (those already receiving dialysis during the time of ICI initiation) and incident patients on dialysis (those who started dialysis after ICI initiation). Charts were reviewed manually to confirm that patients were on HD or PD during the ICI therapy. Clinical details such as demographics, comorbidities, cancer type, immune-related adverse …